Pessaries Are an Option for Pelvic Organ Prolapse

GLASGOW—Vaginal pessaries are an appropriate treatment option for women with troublesome pelvic organ prolapse, but careful maintenance and follow-up are essential, according to researchers.

Sophie Ramsay, MD, and collaborators at Université de Sherbrooke in Sherbrooke, Quebec, studied 429 women who had a pessary trial at their institution. The women had an average age of 71 years and 50% previously had a hysterectomy and 22% had prior prolapse surgery. The median duration of pessary use was 35 months (range 1 to 136 months).

The study showed that 96% of subjects were satisfied or very satisfied with their pessaries and 66% could handle the pessary by self-maintenance. Another 23% needed assistance from a regional nurse and 11% required maintenance by clinic nurses at the researchers' institution.

Pessary self-maintenance was associated with significantly longer use of the pessary compared with the need for assistance (38 months vs. 30 months for those assisted by a regional nurse and 27 months for those requiring clinic nurse assistance). Use of mucolytic cream, compared with non-use, also was associated with significantly longer pessary use (38 vs. 26 months).

The overall erosion rate was 16% and was not associagted with the degree of prolapse.

Use of topical estrogen cream (versus non-use) was associated with a significantly higher rate of erosions (25% vs. 5%), a finding that investigators said was contrary to their expectations.

Constipation (versus no constiptation) and longer duration of pessary use also were associated with significantly higher erosion rates.

The authors noted that 66% of women who underwent a successful pessary trial are still using a pessary.